Trinity Support Services Crisis Stabilization involve direct interventions that provide temporary, intensive services and supports that avert emergency, psychiatric hospitalization or institutional placement of individuals who are experiencing serious psychiatric or behavioral problems that jeopardize their current community living situation. This service is designed to stabilize the individual and strengthen the current living situation so that the individual remains in the community during and beyond the crisis period. Daily activities will be provided to the clients either individually or in group settings.

 

Service may be provided in any of the following settings, but shall not be limited to: (1) the home of an individual who lives with family or another primary caregiver; (2) the home of an individual who lives independently; or (3) community based programs licensed by DBHDS to provide crisis stabilization or emergency services which are not institutions for mental disease (IMDs).

The program shall provide to individuals, as appropriate, psychiatric assessment including medication evaluation, treatment planning, symptom and behavior management, and individual and group counseling.

Crisis Stabilization services may be provided by an LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, QMHP-A, QMHP-QMHP-E or certified pre-screener.

In the event a client emergency requires immediate attention, they are directed to contact the following services:Connect (540) 981-8181, Respond (540) 776-1100.

 

Characteristics of Population

Trinity Support Services, LLC serves Martinsville, Patrick County, Roanoke, Salem, Roanoke County and Franklin County Crisis Stabilization Services to adults who demonstrate a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization

Eligibility Criteria

Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization. Individuals must MEET at least TWO of the following criteria at the time of admission to the service:

1. Experiencing difficulty in establishing and maintaining normal interpersonal relationships to such a degree that they are at risk of psychiatric hospitalization or homelessness or isolation from social supports.

2. Experiencing difficulty in activities of daily living (ADLs) such as maintaining personal hygiene, preparing food and maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized.

3. Exhibiting such inappropriate behavior that immediate interventions by mental health, social services, or the judicial system are or have been necessary.

4. Exhibiting difficulty in cognitive ability (such that the individual is unable to recognize personal danger or recognize significantly inappropriate social behavior).

 

Individuals may not receive Crisis Stabilization when they meet the exclusion criteria below:

 

1) Individuals with medical conditions which require hospital care;

2)Individuals with a primary diagnosis of substance abuse;

3) Individuals with psychiatric conditions which cannot be managed in the community, such as individuals who are of imminent danger to self or others.

 

 

Prescreening/Admission/Discharge Criteria

1.       Upon receipt of a referral for Crisis Stabilization services, the Program Director of Trinity Support Services will review the client's presenting problem, background information and the services requested.The Program Director will make the decision to admit and/or refer the client to other services based on the following criteria:

         Absence of any current suicidal behaviors, plans or intent

         The presence of any current psychotic symptoms and the appropriate intervention

         Assessment by or with a Psychiatrist

         The presence of any safety risks for either the client and/or staff member assigned to the case

         The availability of a staff member whose skills and expertise match those required to make appropriate interventions or provide appropriate services

 

2.       If any client referred for services does not meet admission criteria, that client will be referred to the appropriate service or program.Written documentation will be maintained for a period of 6 months and will include :

         Date of initial contact

         Demographic information (including name, age, gender address and phone number of the individual

         Presenting problem or needs

         Name and credentials of screening staff

         Outcome of screening process, including recommendations and referral made

 

Continued Stay

 

1.       All changes/transitions in a client's treatment will be consistent with the individual needs of the client and will be provided in the least restrictive and most appropriate level of care.Services will be provided for up to 15 days.Documentation of the assessment and coordination of care will be placed in the client record.Prior to any transition in a client's treatment, the assigned staff will perform the following:

 

Assess the individual's service need as follows:

         Interviewing the client regarding future needs

         Obtain information from the referral source

         Review the current clinical record of the client

         Staffing the client's case with supervisor and/or other designated staff to obtain feedback regarding the need for treatment, discharge, continued care and follow up

         Document the above clearly and concisely in the progress note section of the client's clinical record.

 

2.       When it is determined that the client is no longer appropriate for Crisis Stabilization services, the Trinity Support staff will focus on initiating either a smooth transition for discharge or a transition to a more appropriate service/level of care.Based on the finding of the assessment and current need of care, Trinity staff will begin the transition of care by:

         Reviewing the client record to ensure a valid release of information exists to allow the disclosure of information.If not, staff will complete and have client sign a valid release of information before releasing any confidential information to another agency/provider.

         Developing a discharge plan with the client, and if appropriate, client's family, referral source and/or other professionals involved.

         Contacting the referral source for follow up or discharge planning purpose

         Forwarding the appropriate clinical information from the client record to the new service provider. Notifying the client of their right to appeal any decision regarding transition of services or termination of current services.

         This transition of care will be documented in the progress note section of the clinical record.

 

3.       When Trinity Support staff has determined that the client should be transitioned to a different level of care or discharged from Crisis Stabilization services, staff will complete the procedure by completing a discharge summary no later than 10 days from the date of discharge.

 

The discharge summary will contain the following information:

 

         Client's participation in discharge planning

         If appropriate, client's legal guardian participation in discharge planning.

         Reason for admission and discharge from service.

         Client's level of functioning of functional limitations at the time of discharge

         Current psychiatric and medical conditions.

         Progress made in achieving goals and objectives identified in the client's service plan.

         Recommendations on activities, procedures or referrals to assist the client in maintaining functioning

         Status, location and arrangements for future services which have been made

         Date of discharge

         Signature of Trinity Support Services staff who completed the discharge summary.

 

Discharge Criteria

Clients may be discharged from Trinity Support Service's Crisis Stabilization services for a number of reasons.The following is a list of situations that will result in discharge.Discharge from the program include but are not limited to the following reasons:

 

         Client meets the individual goals and objectives outlined in their service plan.

         The individual does not meet the admission criteria.

         Individual is placed in long term nursing home placement related to physical medical needs.

         The individual relocates out of the area being serviced with no intention of returning.

         The individual does not comply with rules of conduct as outlined in Trinity's Policy and Procedure guidelines.

         The individual chooses to receive alternative services.

         The individual is not benefiting from or shows no progress in services.

         The client is incarcerated.

         The client loses his health insurance and is unable to make payments for services rendered.

         The individual refuses services from Trinity Support Services despite attempts to engage the client in services.

         Death of the individual.

 

Staffing Plan

 

Trinity Support Services provides Crisis Stablization services to adults who demonstrate a clinical need for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities.

 

Staffing and hours of Operation:

Crisis Stabilization services may be provided by an LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, QMHP-A, QMHP-C, QMHP-E.

Service may be provided in any of the following settings, but shall not be limited to: (1) the home of an individual who lives with family or another primary caregiver; (2) the home of an individual who lives independently; or (3) community based programs licensed by DBHDS to provide crisis stabilization or emergency services which are not institutions for mental disease (IMDs).In the event a client emergency requires immediate attention, they are directed to contact the following services:Connect (540) 981/8181, Respond (540) 776-1100 or Emergency Outreach Services (540) 981-9351.

 

The proposed staffing plan procedure is as follows:

         Licensed Mental Health Professionals, Counseling Residents and Supervisees in Social Work and Professional Counselor LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, QMHP-A, QMHP-C, QMHP-E will provide Crisis Stablization services to adults.

         An LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, or a Certified Pre-Screener, shall conduct a face-to-face service-specific provider intake as defined in 12VAC30-50- 226. If the intake is completed by the pre-screener it must be signed off by an LMHP, LMHP-supervisee, LMHP-resident or LMHP-RP within one business day.

         Agency Employees acting as Program Managers, Supervisors or Team Leaders shall have experience with the population served and in providing the services outlined in the program.

 

 

Assessment Policy

 

It is the policy of Trinity Support Services to complete comprehensive assessments on all clients.Prior to admission, an appropriate service-specific provider intake, shall be conducted by the licensed mental health professional (LMHP), LMHP-supervisee, LMHP-resident, or LMHP-RP, documenting the individual's diagnosis and describing how service needs match the level of care criteria. Service-specific provider intakes shall be required at the onset of services. The Individual Service Plan (ISP) must be developed or revised within three calendar days of admission to this service. The LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP, certified pre-screener, QMHP-A, QMHP-C, or QMHP-E shall develop the ISP and the ISPs shall be required during the entire duration of services. The Preliminary assessment will be updated and finalized prior to admission and include a preliminary Individualized Service Plan.Trinity Support Services will make reasonable attempts to obtain previous assessments.Assessments for Crisis Stablization services shall include a Psychiatric Diagnostic Interview Examination, which includes a comprehensive assessment and initial plan of care.The assessment will identify the client's physical, medical, behavioral, functional and social strengths, preferences and needs as applicable.Trinity Support Services staff will conduct an interview with the client and/or legal guardian to obtain information to complete the assessment.Program Managers and/or Agency Owner will have full discretion when assigning assessments to be completed.Assessments will be documented in writing or typed on the computer with confidentiality precautions being used at all times.

 

The Comprehensive Assessment will include the following:

         Diagnosis and onset/duration of diagnosis and/or problems and functional limitations if any

         Presenting needs including the individual's stated needs, psychiatric needs, support needs and/or reasons that require consideration, (family dysfunction, homelessness etc.)

         Social, behavioral, developmental, family histories and supports.

         Family dynamics including the ability and/or desire of the family to participate and follow through with treatment if appropriate

         Cognitive functioning, including individual strengths and weaknesses

         Educational, Employment and Vocational status

         Previous interventions and treatments and the outcomes of those interventions and treatments

         Financial resources and benefits

         Health history including current medical problems, medical history, current medications, current and past substance abuse

         Psychiatric and substance abuse history, Co-occurring disorders and circumstances that increase the risk for mental health issues

         History of abuse, neglect, sexual abuse, domestic violence and trauma including physical and psychological trauma

         Legal status, Guardianship, Commitment Representative payee status, relevant criminal charges or convictions and probation/parole status

         Daily living skills

         Housing arrangements

         Ability to access services.

 

After the assessment has been completed, the evaluator will sign, list their credentials and date the assessment.Each client's assessment will be maintained in his/her case record.

 

Crisis Stabilization Individualized Service Plan

 

         An initial ISP will be completed at the time of the face to face assessment. Services shall be medically prescribed treatment directly and specifically related to an active written plan designed and signature-dated by a LMHP, LMHP-supervisee, LMHP-resident, LMHP-RP and QMHP-A, QMHP-C, QMHP-E and the client .

o The ISP must be completed within 3 days of the start of services.

o The ISP should be amended as needed throughout the time of treatment.

 

Trinity Support Service Individualized Service Plan for Crisis Stabilization Services will contain the following:

 

         Shall document the need for treatment

         Shall document the need for and the objectives or goals of treatment and be congruent with the diagnosis and initial evaluation of the individual

         Shall include a treatment regimen, projected schedule and a schedule for re-evaluation

         Shall be amended as needed throughout treatment

         Shall indicate a focus related to the diagnosis and will have a DSM-V psychiatric diagnosis including current mental status documented in the progress notes.

         Shall indicate individual client specific goals related to the client's symptoms and behaviors.

        Shall include the individual's goals and measurable objectives to meet the identified needs

         Shall include an individualized discharge plan that describes transition to other appropriate services.

         Shall indicate an estimated length of treatment

         Shall indicate the frequency of treatment.

         Will be signed by a qualified provider and dated.

 

Documentation Policy

Trinity Support Services shall maintain a record of each individual client that specifically addresses the individual's care and treatment.All individual client records will be maintained in a locked file room at the office where services are rendered (either 3005 Williamson Road, Roanoke, VA 24012 or 601 Starling Avenue, Martinsville, VA (24112) All individual client records will be maintained in accordance with HIPPA guidelines.Only designated Trinity Support Services staff will have access to individual client records by unlocking the file room door and removing the record.

 

The following procedure will be used to maintain documentation for Crisis Stabilization Services:

         All documentation of progress will be completed on a daily basis.Progress notes will be signed and dated by the person completing the documentation.

         The client demographic information will be updated any time changes occur and signed and dated by the person making the entry.

         Each individual receiving services shall have identifying information in their record, including a unique identification number, name, current address, social security number, gender, date of birth, name of guardian/authorized representative,, marital status, name address and telephone number of an emergency contact and the date of admission to service.

         The Individualized Service Plan and daily progress notes will be signed and dated by the staff rendered the service.

         If a documentation error is made, staff will use a strike mark to mark through the error and then initial.